Individual
OWEN STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5333 MCAULEY DR, SUITE 6016, YPSILANTI, MI 48197-1014
(734) 712-8350
(734) 712-8251
Mailing address
5333 MCAULEY DR, SUITE 6016, YPSILANTI, MI 48197-1014
(734) 712-8350
(734) 712-8251
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
57012650
OH
2085R0202X
Diagnostic Radiology Physician
MD443256
PA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
4301083869
MI
2085R0204X
Vascular & Interventional Radiology Physician
MD443256
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102628033
—
PA
Enumeration date
09/19/2007
Last updated
07/09/2021
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